Presentation
History of fall on the left shoulder. Currently complains about vague, but constant pain with mild shoulder instability.
Patient Data
After injection into the glenohumeral joint a large portion of contrast solution escapes through an inferior capsular tear. The inferior glenohumeral ligament (IGHL) is discontinuous at the humeral insertion and irregular (the so-called 'J sign') glenohumeral ligament (HAGL) avulsion tear is to be seen.
Partial tear of subscapularis tendon fibers from the articular side.
Slightly altered signal intensity of the intraarticular portion of LHBT - possible tendinopathy.
Irregularity and inhomogeneous signals of glenohumeral articular cartilage - degenerative changes (and possibly posttraumatic).
Degenerative changes of the acromioclavicular joint.
Case Discussion
Humeral avulsion of the glenohumeral ligament (HAGL) is a traumatic lesion of the inferior glenohumeral ligament (IGHL), which occurs at its humeral insertion or in mid-portion (in opposition to GAGL, which is found at the glenoid insertion of IGHL).
IGHL is the most important static stabilizer of the humeral head during maximal abduction in the shoulder joint. It is reliably found in over 90% of cadaver shoulder joint studies. Despite these facts, the avulsion of this ligament may be in many cases asymptomatic.
It is a difficult lesion to diagnose using MRI without direct intraarticular contrast usage. In this case, the outflow of the contrast agent was clearly visible even at the time of injection, which was performed under fluoroscopic guidance.